Improving Care Coordination with Nationwide Data Exchange

Session #40, February 12, 2019

Arthur Lauretano, Chief Medical Officer, Circle Health

Jitin Asnaani, Executive Director, CommonWell Health Alliance

Arthur M. Lauretano, MD, MS, FACS

Has no real or apparent conflicts of interest to report.

Jitin Asnaani

Has no real or apparent conflicts of interest to report.

Conflict of Interest

• Barriers to nationwide interoperability today

• How physicians are gaining access

• A clinician’s perspective on data exchange

• Enabling better coordinated care

Agenda

• Describe the barriers that hinder scalable, nationwide,

vendor-neutral interoperability today

• Identify how physicians are gaining immediate access to

relevant patient information to improve patient care

• Explain how better coordinated care can reduce tests, time

and costs as well as improve outcomes

Learning Objectives

Barriers that hinder scalable,

nationwide, vendor-neutral

interoperability today

The average person sees more than

18 providers in their lifetime

And each provider has their own EHR(s)

and other clinical data sources

Patients believe that their physicians

have access to all their health data

But we all know the reality: Health data

information is still very siloed

• Competing priorities:

• Within the government

• Across the health IT vendor community

• At the Provider Organization level

• At the Physician level

• Few tightly-constrained standards for data sharing and patient

matching

• Most data sharing agreements are either at a regional or local

level or a provider-to-provider single connection

So what is standing in the way of

nationwide health data exchange?

Current interoperability approaches

simply don’t scale

Community

Hospital

IDN

Pharmacy

Lab

Post-Acute

Specialist

PCP

Clinic

• In this example alone, 28 distinct

point-to-point interfaces

• Organizations are forced to create

contract-by-contract interoperability

between local IT systems

• Regional “networks” achieve only

regional results

• U.S. Census Bureau (2018):

the percentage of people that

move every year equates to

14% of the population (~40M)

Ask patients to

remember their

clinical history

Request a fax+

Care Coordination is too dependent on

the patient and on archaic technology

How physicians are gaining immediate

access to relevant patient information

nationwide

Ask patients to

remember their

clinical history

Know where

patient has

been

Request a fax

Get the data

within the

workflow

We are solving a hard problem

We created a person-centered network

CommonWell Services

1. Enroll individuals in the network

2. Find their records

3. Match and Link their records

4. Broker queries and responses

5. Notify when patients have

encounters

1. Enroll individuals in the network

2. Find their records

3. Match and Link their records

4. Broker queries and responses

5. Notify when patients have

encounters

EHR

EHRHIT

HIT

EHR HIT

The network is live and connected

across the nation

Acute Ambulatory

Patient

Access

Home Health

Critical

Access

Rehab/LTC

11,000+ provider sites

45M+ enrolled individuals

20M+ patient records retrieved

We have partnered with Carequality to provide

connectivity beyond our network

Sequoia Project and

CommonWell to explore

collaboration opportunities in the

future

CommonWell to implement

Carequality Directed Query

specification

Basic version of CommonWell

Record Locator Service (RLS) to be

available to Carequality

Implementers

CollaborationCollective Success

Together, members and participants

from both organizations represent:

90%

of acute EHR market

60%

of ambulatory EHR market

Source: KLAS and SK&A, a Cegedim Company

“Physician Office Usage of EHR Software” SK&A. February 2017.”

We are preparing for Federal Regulation

From a Clinician’s Perspective

• Lowell is the 4

largest city in

the Commonwealth of

Massachusetts

• Lowell General merged with

Saints Medical Center in 2012

to form 2

largest community

hospital in the State

• 8

largest hospital in the state

• HIMSS Stage 6 on the EMR

Adoption Model

• Received Magnet Recognition

for quality patient care

Who We Are

About Circle Health

3,500+

associates

2 hospitals & 18

ambulatory clinics

280,000 + annual

annual outpatient

visits

396 Beds

2,269 annual

births

660 physicians

• Circle Health /

Lowell General Hospital

• Tufts Medical Center

• Melrose / Wakefield Hospital

• Lawrence Memorial Hospital

About Wellforce

Circle Health EHRs / EMRs

Currently, 12 EMR/EHR Systems:

• eClinicalWorks

• Cerner

• ComChart

• SpringCharts

• HDox

• SuiteMed

• SRS Freedom

• athenahealth

• Allscripts

• ICS

• Epic

• AdvancedMD

• Desire to find specific

data

• Push technology

yielding too much data

• Delay in receiving

information, including

faxed information

The challenges our clinician’s faced

every day

Truly patient-centered care

Timely access to information

Specificity of information

Simplicity of use

Easy, quick implementation

Consolidated view of the patient records

Immediately electronically available

Refined to the necessary information

Built right into your current software and

workflow

In less than 6 months, rolled out to

5,400+ facilities

Today’s reality with CommonWell

• CommonWell doesn’t store any of the clinical data

• Enrollment/Consent Process is simple when incorporated into

standard check-in process

• Patients actually get what they believe already exists – provider

access to all of their records

Dispelling the myths

How better coordinated care can

reduce time, tests and costs, as well

as improve outcomes

For those patients whose records are not yet connected to

CommonWell:

Reduce time

30% of the

time asking office staff to

track down missing

patient

information

Clinical Scenario: Thyroid Nodule

• Patient sees specialist for thyroid

nodule identified on ultrasound;

referred from an outside system

• If the ultrasound result is not easily

accessible, we would often repeat

it in our own system, possibly at a

different date, requiring additional

visits and copays

• Delay in treatment, increased

patient anxiety, decreased patient

satisfaction

Reduce tests

Clinical Scenario: Pediatric Cancer Scare

• A recent 12 year-old-patient came to me

because her MRI report was interpreted

to the parents as showing an “abnormal

shadow” – PCPs office staff led family

to believe this was possibly cancer

• Access to PCP note with MRI report –

“Dental artifact from patient’s braces”

• Obviated need for CT (cost and

radiation exposure) and resolved patient

and family anxiety

Reduce costs (and increased peace of mind)

Clinical Scenario: Chest pain patient in the Emergency Room

• 55-year-old male with chest pain, new to the facility

– CommonWell access to PCP notes:

• Smoker, high cholesterol, father died at 52 - MI

• 55-year-old male with chest pain, new to the facility

– CommonWell access to PCP notes:

• Has been seen multiple times in the last two weeks, pulled a

muscle, but wanted to be assessed for CAD

– Cardiology workup, including stress test, was negative

Improve processes and outcomes

• Access records from providers across the nation, not just locally

• Electronic access, available immediately if/once linked

• Better quality of care with reduced costs (appropriate tests, not

duplicate tests) – Better Healthcare Value

• Better Patient Experience

• Contribution to the Triple/Quadruple Aim

Benefits of CommonWell

• It is critical to have access to a patient’s information regardless of

where prior care has occurred nationwide

– Point-to-point connections are not scalable

– Regional-only solutions can be valuable but have limited

visibility into the patient story

– Nationwide connectivity is required to serve our large

mobile population

Takeaways

• With person-centric health information at the touch of your finger,

providers can achieve:

– Better understanding of the patient context

– Better coordinated care

• Reducing tests, time and costs

• Improving outcomes

Takeaways

Arthur M. Lauretano, MD, MS, FACS

Chief Medical Officer

Circle Health

Arthur.Lauretano@circle-health.org

Jitin Asnaani

Executive Director

CommonWell Health Alliance

jitin@commonwellalliance.org

@jitin

Questions

Please complete the online evaluation (Session #40)